Outcome to the Department for Transport’s consultation on proposals to extend Blue Badge eligibility to people with non-physical conditions.

No Automatic eligibility for those scoring 12 points on ‘cannot follow the route of a journey without another person’ criteria means
most ASC people will not qualify for a Blue Badge under new proposals. Allowing only those that score 10 points automatic eligibility, whilst specifically
excluding those that score 12 points, who paradoxically have greater disability, excludes most people with autism who will score either 8 points or 12 points on this question.
The people who score 12 points are those that can access the motability scheme to get a car but they will not be entitled to a blue badge, whilst those who score 10 points can have a blue badge but no Motability car (making the blue badge useless). Simple rules in Scotland and Wales provide automatic eligibility for 12 points under ‘cannot follow the route of a journey without another person’ criteria but not in England under the Conservative Party which exclude those most in need from any help (as usual), whilst of course claiming they will improve the system to help those with invisible disabilities. A change only forced on the government by an anti-discrimination legal court ruling, not through fairness
or compassion.

PART 2 – EXECUTIVE SUMMARY

7. The Department was delighted to receive over 6300 responses to the
consultation and for the time that individuals and organisations took to provide
considered responses.
8. The Blue Badge scheme plays a vital role in allowing 2.4 million disabled
people in England to maintain their independence through special national
parking concessions. Blue Badges enable their holders to visit their families
and friends, and to access jobs, healthcare and leisure activities.
9. Although the Department considers that people with non-physical disabilities
are not excluded from receiving a Blue Badge, a problem arises from the
wording in the regulations providing eligibility for: “a permanent and
substantial disability which causes inability to walk or very considerable
difficulty in walking”. This does not specify whether the disability is physical or
non-physical – and can therefore be either. However there is confusion
around whether this only means physical difficulty in putting one foot in front
of the other or can include difficulties or challenges when walking, including
safety risks, which may arise from non-physical disabilities.
10. The Government wants to ensure that the rules and guidance are clear. It
wants to give parity of esteem to mental and physical health conditions. It
wants a scheme that is sustainable and works for all who are eligible for it,
whatever their disability. It wants it to be fair, consistent, inclusive and nondiscriminatory.
11. We are delighted that 89% of respondents are, in principle, in favour of our
proposals to amend the eligibility criteria. This support applies to all groups –
local authorities 71%, groups representing disabled people 84%, other
organisations 87% and individuals 89%. The main points raised were more to
do with implementation and consequential impacts. There was a call for
clarification of certain terms and the provision of clear guidance so that local
authorities can administer the scheme consistently. There were also concerns
about administration costs for local authorities, the impact on parking, and
abuse of badges.
12. Based on responses to the consultation, the Department continues to believe
that including people who have very considerable difficulty “when walking” as
opposed to just “walking” as now, will make it clear that people can qualify not
just because of a physical difficulty in walking but for non-physical reason

14. There is one area where the consultation has persuaded the Department tochange its proposals. We had proposed specifically including people who‘cannot follow the route of a journey without another person’. However, it hasbeen made clear that this would mean including some people who needanother person with them, but can otherwise physically walk well and alsowithout psychological distress or challenging behaviours. The Departmentbelieves that where people suffer very considerable psychological distress orother difficulty when walking, or have a risk of very considerable harm to theirhealth or safety (including people with dementia), they should be eligible for abadge. However, where the applicant would not go out alone and thepresence of another person negates the above mentioned issues, then we donot believe badges should be issued. Needing another person on everyjourney does not necessarily equate to needing to park nearby.

15. The primary aim of the scheme is to give disabled people who rely on car
travel but face particular challenges in getting from the car to their
destination, the ability to park close-by. The Department believes the badge
should directly benefit the individual; to ensure the sustainability of the
scheme we do not believe badges should be awarded in situations where the
carer is effectively the beneficiary.

16. For the same reason the Department intends to provide an automatic link to abadge for people who score 10 points under the ‘Planning and followingjourneys” activity of Personal Independence Payment (PIP) because cannotundertake any journey without overwhelming psychological distress to theclaimant. We had proposed to link to 12 points under this activity, for peoplewho cannot follow the route of a familiar journey without another person, butthis would include people who do not have very considerable difficulty whenwith another person and do not need to park close to where they are going. Itwould not be sensible to award an automatic badge in this scenario.

This PIP criterion is not about needing to park a vehicle near to one’s destination. The
Department recognises that some people with significant challenges who
receive different levels of PIP may not have an automatic route to a badge.
This is because PIP and Blue Badge are different schemes that are not
completely compatible. However under our proposed new and expanded
eligibility criteria we are confident that people who experience very
considerable difficulties because of non-physical disabilities will now have a
clear route to a badge following assessment by their local authority.
17. Since 2012, the Government has required that where eligibility against the
walking criterion is not self-evident and an expert opinion is needed to help
determine eligibility, the local authority must use an Independent Mobility
Assessor who is independent of the applicant.
18. Following consultation, the Department continues to believe this role should
be widened. An independent mobility assessor may not be suitable for
certifying whether or not a person’s mental or cognitive disability has the
impacts that would meet the eligibility criteria. In the first place, the assessor
would not be assessing the physical ability to walk. So we believe the
assessor should become an eligibility assessor rather than a mobility
assessor. Furthermore, whereas a person with a physical disability may be
adequately assessed without the assessor having prior knowledge of their
disability, this may not be the case for a person with a non-physical disability.
Often such an assessment would require knowledge of the person’s
functional limitations when outdoors. We are therefore proposing to remove
the requirement for independence, but that does not mean a local authority
should not use an independent eligibility assessor where deemed
appropriate. This will allow the local authority to use a range of suitably
qualified healthcare professionals with specific expertise. The assessor role
does not have to be performed by a specific person – the authority will have
the flexibility to choose who they recognise as being suitable to provide an
expert opinion and it may vary from case to case, so long as the assessor
has relevant qualifications and experience to assess whether or not the
applicant has an enduring and substantial disability within the meaning set
out in the regulations. Respondents called for guidance as to who could fulfil
the assessor role and what qualifications they should have.
19. Respondents also called for clarity on a number of terms used across our
proposals, including “walk”, “journey” and “enduring” amongst others. The
Department will seek to define what these mean in guidance.

Blue badge parking permits are to be made available for people in England with “hidden disabilities” such as autism or mental health problems.

The Department for Transport said people with non-physical disabilities would have an equal right to free parking from next year.

Currently the rules do not explicitly exclude hidden disabilities, but councils’ interpretations can vary.

Similar changes have come into effect in Scotland and Wales.

When the changes to the blue badge scheme in England are introduced, they will extend eligibility to:

people who cannot make a journey without “a risk of serious harm to their health and safety” or that of others, such as young children with autism
people for whom travel causes “very considerable psychological distress”
and those with considerable difficulty walking, meaning “both the physical act and experience of walking”
About 2.4m disabled people in England currently have a blue badge.

The scheme, first introduced in 1970, allow holders to park for free in pay-and-display spaces and for up to three hours on yellow lines.

The badges cost £10 and in London they also provide an exemption from the congestion charge.

Thousands share invisible disabilities
Transport Minister Jesse Norman said: “Blue badges are a lifeline for disabled people, giving them the freedom and confidence to get to work and visit friends independently.”

The change follows a consultation launched in January which saw 6,000 responses.

Three in four disabled people say they would go out less often without the parking permit, the DfT said.

‘Overwhelming anxiety’
Jane Harris, director of external affairs at the National Autistic Society, said the change would “make a massive difference to the lives of many of the 600,000 autistic people in England, and their families”.

Many autistic people experience major challenges in travelling, making detailed preparations and suffering “overwhelming anxiety” about things going wrong, she said.

She said that some can be unaware of the dangers of the road while others can feel panic in busy or loud environments.

Scotland and Wales have already changed their eligibility criteria for the Blue badge scheme to include some mental impairments, where people cannot follow the route of a journey without assistance, but the rules are yet to be altered in Northern Ireland.

Why are some of us more inclined than others to stick up for ourselves, not aggressively, but assertively. Assertive people let others know when they feel mistreated and they’re confident saying “no” to unwanted demands.

Presumably it has to do with how see ourselves, yet past research has established that two key aspects of the self-concept – good feelings about the self (“self-liking” or “self-confidence”) and seeing oneself as competent – are not strongly related to assertive behaviour.

Daniela Renger, a researcher at the Institute of Psychology at Kiel University in Germany, believes this is because most relevant to assertiveness is self-respect – “a person’s conviction that they possess the universal dignity of persons and basic moral human rights and equality”. Across three studies published in Self and Identity, Renger shows that self-respect is a distinct psychological concept and that it is uniquely correlated with assertive behaviour.

For her studies, Renger devised a new, four-item self-report measure of self-respect. Participants rated their strength of agreement with:

In everyday life I always see myself as a person with equal rights
I always see myself as a person of equal worth compared with other people in my life
I am always aware that I have the same dignity as all other human beings
If I look at myself, I see a person who is equally worthy compared with others

In an initial study, 343 women and men in Germany (average age 33) completed this measure, plus questionnaires tapping their self-competence (e.g. “I am almost always able to accomplish what I try for”) and self-confidence (e.g. “I look at myself with warmth and affection”; “It is always worth taking good care of myself”). They also completed an 8-item measure of assertiveness, for example saying whether they would feel comfortable “telling a companion you don’t like a certain way he or she has been treating you”. Nearly a hundred of the participants completed these same questionnaires again nine months later.

Based on her analysis of the participants’ answers to the various measures, including the correlations within and between them, Renger concluded that self-competence, self-confidence and self-respect are distinct aspects of the self-concept. Also, while all three factors correlated with assertiveness, only self-respect had a unique association with assertiveness when accounting for the other two factors. Finally, there was some tentative causal evidence: having greater self-respect at Time 1 correlated with increased assertiveness as measured 9 months later, but the reverse was not true (having greater assertiveness initially was not associated with increased self-respect).

According to the Extreme Male Brain theory of autism, there are certain cognitive and behavioural characteristics that manifest more often in men than women, on average, such as a bias for systematic rather than empathic thinking. Autism can be seen as as extreme version of that typical male profile, the theory proposes, possibly caused by prenatal exposure to higher than usual amounts of testosterone in the womb.

A related observation is that exposure to high concentrations of prenatal testosterone leads to the development of “hyper masculine” facial features. It follows that if the Extreme Male Brain theory of autism is accurate, then autistic people will have hypermasculine faces.

A new study in Scientific Reports put this logic to the test, and consistent with the Extreme Male Brain theory, found that autistic girls and boys had more masculine faces as compared with neurotypical control children.

Past research into whether autistic people tend to have stereotypically masculine facial features has been mixed. Women with sub-clinical autistic traits or a diagnosis of autism have been found to have more masculine than average faces, but studies with autistic men have sometimes found no difference from controls, or they’ve found the autistic men to have androgynous rather than hyper masculine features.

For their new paper, the research team led by Diana Tan at the University of Western Australia, deliberately sought to test pre-pubescent autistic and neurotypical children, thus removing the possibility that hormonal changes during puberty might conceal or reverse any facial signs of prenatal exposure to high testosterone levels (as may have been the case in the earlier research involving adults).

Tan and her colleagues also employed a new 3D facial mapping process, tested on 48 neurotypical boys and 53 neurotypical girls, to provide a highly accurate and objective measure of the facial features that most typify a male and female child’s face. Using these features, the researchers’ algorithm was able to correctly categorise the sex of children’s faces with around 98 per cent accuracy.

Next, the researchers deployed their 3D facial mapping algorithm to score the facial features of 54 caucasian autistic boys, 20 caucasian autistic girls and age-matched neurotypical caucasian boys and girls. This showed that the autistic boys and girls had more masculine than usual faces – to use the researchers’ jargon, their faces were hypermasculinised.

Moreover, when the researchers compared the autistic children and control children’s faces on the six facial features (mostly related to the positioning of the nose and upper lip) that most strongly distinguished neurotypcial boys’ faces from girls’ faces, the autistic kids of both sexes were found to have a more masculine score than controls on five of these features.

Finally, among the autistic boys and girls, the more masculinised their faces, the more social and communication difficulties they tended to have, as scored in their diagnostic test for autism.

The sample sizes for this study were relatively small, but the study’s biggest weakness is that it asks us to make a logical leap – high prenatal testosterone levels are known to cause faces to appear more masculine, autistic children have more masculine than average faces (as shown by the new results), therefore high prenatal testosterone levels contribute to autism (in line with the Extreme Male Brain Theory). However, as the researchers’ themselves acknowledge, this study featured no data on the testosterone levels that the children were exposed to prenatally, meaning there could be other explanations for the results. “Further investigation that tracks longitudinal links between early testosterone exposure, postnatal facial morphology and autism phenotype will provide more direct tests of the hypothesised relationships,” they said.

The Extreme Male Brain theory has inspired important research into the causes of autism, but it has also been controversial. Cordelia Fine, the author of Delusions of Gender and Testosterone Rex, cites the theory as an example of contemporary “neurosexism”. And other recent research has uncovered findings that are inconsistent with the theory – for instance, last year a brain imaging study found that, compared with male neurotypical controls, autistic boys and men had resting connectivity patterns that resembled what’s more typically seen in women, while autistic girls and women showed a more masculine neurological profile, lending support “to the notion that autistic spectrum disorder may constitute a disorder of sexual differentiation or androgeny rather than a disorder characterized by masculinization in both genders.”

Ministers have been accused of ignoring a public consultation and ploughing ahead with plans that will make their “fitness for work” testing regime even more stressful and unfair for sick and disabled people.

A presentation delivered by two senior Department for Work and Pensions (DWP) civil servants earlier this month suggests that ministers have decided – as many disabled activists feared after the publication of last year’s green paper – to introduce new benefit sanctions for sick and disabled people with the highest support needs.

The presentation at a DWP “Operational Stakeholder Engagement Forum” appears to confirm that the government had decided how it would reform the system of out-of-work disability benefits before its “consultation” process had finished on 17 February.

The government had claimed that it wanted to make the work capability assessment (WCA) less of an ordeal for claimants, with work and pensions secretary Damian Green telling last October’s Conservative party conference he wanted to support those disabled people who cannot work, and “sweep away unnecessary stress and bureaucracy which weighs them down”.

But slides from the presentation appear to show that his new regime will be even harsher, and that many employment and support allowance (ESA) claimants with the highest support needs and barriers to work will for the first time face having their benefits sanctioned if they do not co-operate with the regime.

The slides show DWP has already begun introducing a compulsory, face-to-face “health and work conversation” (HWC) with a jobcentre work coach that will apply to nearly all new claimants of ESA, weeks or even months before they go through the WCA process to decide whether they are not fit for work and eligible for the benefit.

The presentation says that “vulnerable” claimants will not have to take part in the face-to-face HWC.

A DWP spokesman has told Disability News Service (DNS) that work coaches will be “issued clear guidance on who will be exempted from the HWC” and “will also be able to defer the HWC if the claimant cannot attend due to temporary circumstances”.

But disabled activists have warned that these decisions will be taken by non-medically trained civil servants.

The slides say: “Currently Jobcentre staff do not routinely engage with ESA claimants before the Work Capability Assessment (WCA) which can take place many months into the claim.

“We know that the start of the claim can be a challenging time for claimants and that the longer a claimant is on benefit, the more difficult it is for them to move into employment where appropriate.

“The Health and Work Conversation (HWC) will provide this early support to claimants.”

The presentation said the HWC – which it claimed was co-designed with some disabled people’s organisations – will draw on “behavioural insight techniques and research” to “develop voluntary action plans” and help claimants “move closer to the workplace”.

And it said that all new ESA claimants would have to sign a new “ESA Claimant Commitment”, which would “set out the expectations and legal requirements that claimants will be required to accept in order to receive ESA”.

One of the outsourcing giants paid to assess disabled people for their eligibility for benefits appears to have admitted that it is standard practice – approved by the government – to ask claimants with mental health conditions why they failed to take their own lives.

A leading clinical psychologist has warned this week that such questioning “brings huge risks” and is one of the reasons behind the increase in suicides associated with the government’s work capability assessment (WCA) process*.

The admission from Maximus, which carries out WCAs for the Department for Work and Pensions (DWP), came after a disabled campaigner produced a recording of his own assessment.

On the recording, shared with Disability News Service (DNS), a Maximus assessor – an occupational therapist – is heard asking Jonathan Hume a series of questions during his WCA, while typing on a keyboard.

She asks him [his replies have not been included]: “Back to some questions that we have to cover…

“Have you ever tried to harm yourself or take your own life or needed to go to hospital?

“Do you have any thoughts around that at the moment, any intentions or plans to hurt yourself currently?

“When you say desires, how often are you having thoughts like that?

“And what is it that stops you from acting on the thoughts that you have?

“Can you think of any reason that you’re not doing that? Is it friends or family support?”

Hume’s assessment took place in Sunderland last September, and both Maximus and DWP appear to have conceded that the DNS transcription of the questions is an accurate description of what took place.

Hume came forward after fellow disability rights activist Alice Kirby sparked a horrified reaction on social media last week after revealing how the healthcare professional who assessed her eligibility for personal independence payment (PIP) had asked her: “Can you tell me why you haven’t killed yourself yet?”

After she shared her experience, many other claimants came forward to say that they had been asked the same, or a similar, question by their assessors.

Hume said he had raised concerns with Maximus about the questioning by email on the day of his assessment, before he knew the result of his employment and support allowance (ESA) claim.

He told DNS: “As both clinicians and claimants have made clear, the WCA is a hostile, stressful and coercive situation and the carelessness and brutality with which these questions are asked has the potential to do a great deal of harm to vulnerable people, many of whom are already avoiding claiming their rightful benefits due to a system which is degrading and stressful from the first phone call.

“We are forced to justify our very survival in a hostile context to answer questions which are only dubiously related to the legal criteria of ESA.

“Such information, if truly necessary for the claim, could be gained in so many other ways that avoid putting claimants in significant distress and risk, such as written statements from the claimant’s therapists or other carers.

“There are no grounds to continue such questioning.”

Dr Jay Watts, a clinical psychologist and academic, told DNS that people should only be asked about suicidal ideation by a trained professional who can offer help or someone in an “existing trusting relationship with the individual”.

She said that WCAs were “degrading and humiliating experiences for most if not all claimants” and were carried out in a space which was “not a trustworthy one”.

She said: “Individuals are required to parade their distress and feel compelled to answer intrusive questions (for the means to live relies on this).”

She added: “To ask about suicide or self-harm in this context brings huge risks.”

And she said that such questioning “can be suggestive if the environment is unsafe.

“If someone is low or anxious, for example, made to feel they are a ‘skiver’ for needing benefits, an implication that if they were really ill they would have killed themselves can be the final straw. It may lead directly to an attempt on one’s life.”

She said that claimants were “battered with multiple questions about that which is most personal” in disability assessments and questioned about suicide while the assessors are “typing away” on their keyboards.

Watts said: “I have no doubt that questions on suicidal ideation, and the degrading manner in which they are asked, are one reason behind the suicide spike associated with the WCA process.”

She called on Frank Field, chair of the Commons work and pensions committee, to carry out an urgent review of the way disability benefit assessments are carried out.

In a statement, a Maximus spokesman said that its role was “to carry out high quality and sensitive functional assessments”.

He said: “Mr Hulme [sic]contacted us last year and a doctor reviewed the recording of his assessment and the report.

“We are satisfied that the healthcare professional who conducted the assessment did so in line with our policies and guidelines.

“Every healthcare professional we employ is trained to ask people with a mental health condition a series of clinical questions to assess how their condition affects their daily lives.

“The assessment report was passed to the Department for Work and Pensions, who make the decision on eligibility for benefits.”

He had failed to clarify by noon today (Thursday) whether the questions asked of Jonathan Hume were standard questions; if DWP was aware that such questions were being asked in assessments; and whether Maximus and DWP believed that they were appropriate and safe questions to ask of someone in his situation.

Despite requesting a copy of the recording, which was provided by DNS – with Hume’s agreement – DWP also failed to provide clear answers to a series of key questions.

These include whether it accepted that the questions were asked in Hume’s assessment; whether asking such questions was appropriate and safe in an assessment, particularly for assessors who are not trained mental health professionals; and whether these were standard, DWP-approved questions asked of ESA and PIP claimants with suicidal ideation.

Instead, in response to the DNS questions, a DWP spokeswoman said: “We are not aware of any complaints made to DWP on this issue, but would investigate any allegations thoroughly.

She said that assessors “receive training in order to conduct functional assessments on behalf of the DWP and their training includes conducting a mental health assessment which may, if appropriate, include questions about suicide or self-harm.

“Health professionals are medically qualified professionals and as such, they should have the appropriate skills to enable them to deal with people in a supportive and sensitive way.

“If an individual has mental health issues or a there is an indication of suicidal thoughts or intentions, this will be given careful and sensitive exploration to establish the circumstances.”

She added: “There is a duty of care to act where appropriate, for example if the individual is considered to be in substantial and imminent risk.

“Both the department and our contracted providers have a duty of care where there is any indication or possibility of suicidal thoughts or intentions, and it would therefore not be appropriate to not explore this further.”

Government-funded research by public health experts from the Universities of Liverpool and Oxford concluded in late 2015 that the programme to reassess people on incapacity benefit through the WCA was linked to 590 suicides in just three years. Maximus declined to comment on the research at the time.